Top Compliance Gaps In Employer-Sponsored Health Plans

Below are the most common compliance gaps found in employer-sponsored health plans.

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  • Employers are not permitted to use the appropriate benefit selection form to obtain a signed deduction agreement from the employee. If the election/approval form is not used, the company must make a negative decision in its country of copy documents in order to make pre-tax deductions.
  • DOL requires employers employing more than 100 workers to submit an annual form 5500 detailing benefits for each line of coverage provided. DOL requires the use of a packing slip if an employer requests more than one support on one form 5500. Many companies filed multiple benefits from the same 5500 without using "SPD document wrap".
  • Employers are required by Medicare and Medicaid Service Centers (CMS) to disclose annual credit or non-credit coverage to all eligible employees. The notification must be distributed to all eligible employees by November 15th. Although an employee may or may not qualify for Medicare, their spouse or loved one may qualify for Medicare coverage based on their age or disability.
  • Employers are also required to provide Medicare and Medicaid Service Centers (CMS) with an annual report on credit or non-credit coverage. Notification must be given within 60 days from the date of renewal. Coverage is considered "trustworthy" if the prescription drug compensation under the plan is expected to pay at least the standard Medicare coverage.